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Harry Quigley, Sandra Cassard, Emily Gower, Pradeep Ramulu, Henry Jampel, David Friedman; The Cost of Glaucoma Care Provided to a Sample of Medicare Beneficiaries from 2002--2009. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2657.
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© ARVO (1962-2015); The Authors (2016-present)
To estimate payments for glaucoma care among Medicare beneficiaries from 2002 to 2009.
Data from a 5% random subsample of Medicare billing information from the years 2002 through 2009 were collected from the carrier, outpatient hospital, inpatient hospital and beneficiary summary files. Medicare beneficiaries with both Parts A and B, fee for service enrollment for > 1 month during the year, who had one of a defined set of glaucoma diagnostic codes were included if they had one glaucoma visit, glaucoma diagnostic test, or glaucoma laser/surgical procedure. Groups coded as open angle, angle closure, or other glaucoma were categorized separately. Claims were classified into glaucoma care, other eye care and other medical care.
In 2009, overall glaucoma payments were $37.4 million for the 5% sample, for an overall estimated cost of $748.4 million, or 0.4% of all Medicare payments. Office visits comprised nearly one-half of glaucoma-related costs, diagnostic testing was about one-third, and surgical and laser procedures were about 10% of costs each. Coded OAG and OAG suspects accounted for 87.5% of glaucoma costs, while cost per person was highest in other glaucoma, followed by ACG, then OAG. Fewer than 3% of OAG patients were estimated to undergo surgery and about 5% had laser trabeculoplasty in 2009. Payments for ACG patients were headed by laser iridotomy (35% of their total). Other glaucoma patients had the highest proportion of costs devoted to surgery (26% of their total), particularly tube—shunt surgeries. The non-glaucoma eye care for glaucoma patients was 67% higher than that for glaucoma care, chiefly related to cataract surgery and diagnosis/treatment of retinal diseases. From 2002 to 2009, glaucoma care costs rose 30% (p<0.001 by test for linear trend) and the cost per person per year rose from $197 to $228 (p<0.01 by test for linear trend), due to increased reimbursement for visits, an increased number of OAG suspects, more higher-level visits, and more laser and surgical procedures.
Payments for glaucoma were less than 1/200th of all Medicare payments, increasing from 2002—2009 at less than the rate of general or medical inflation. Cataract and retinal eye care for glaucoma patients substantially exceeded the cost of their glaucoma care. Visit charges represent the largest category of costs.
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